tbuckley/cabot-search huggingface dataset:
Abstract P362: Racial Disparities in Cardiovascular Disease Mortality: Mediation by Socioeconomic Factors and Statin Use (The ELSA-Brasil Study)
Authors: Aline Pedroso-Camargos, Luisa C Brant, Antonio L Ribeiro, Luana Giatti, Lidyane V Camelo, Maria de Fatima H Diniz, Sandhi M Barreto, Roberta C Figueiredo
Journal: Circulation (2023)

Background: Statins are an effective strategy to reduce CVD risk, however, treatment goals are not achieved especially among Blacks and “Pardos” in Brazil. Hypothesis: Socioeconomic differences and lack of statin treatment for primary CVD prevention can explain part of the elevated mortality risk of Blacks and “Pardos”. Methods: Data from the ELSA-Brasil cohort (15,105 civil servants, from 6 state capital cities), excluding Asians, Indigenous, those with prevalent CVD and missing information about race or statin use. Race was self-reported as Black, “Pardo” or White. Brazilian guidelines at baseline (2008) were used to define those eligible for statin treatment. Cox survival analysis determined the risk of CVD mortality for Black and “Pardo” compared to White (adjusted by age, sex, hypertension, diabetes, LDL-c, BMI and smoking). We used inverse odds ratio weighting technique to calculate mediation for socioeconomic factors (SEF) (education, income, and having health insurance) and statin use when indicated to determine the natural direct and indirect effects of race on CVD mortality. We estimated the percent mediation as the percent change between β coefficients with and without weights applied. Results: Among the 13,396 individuals, the mean age was 52±9 years, 55.2% were women, 54.2% were White, and 10.2% were taking statins. Adjusted Black and “Pardo”/White CVD mortality HR was 1.91 (CI 95% = 1.30-2.81, p&lt;0,001). The direct effect of race on CVD mortality when considering the weight of SEF was 1.37 (CI 95% = 0.86-2.19) and considering the weight of statin use was 2.01 (CI 95% =1.36-2.98). SEF explained 51.5% (CI 95% = 17.0-60.2) and not using statins when indicated explained 7.8% (CI 95% = 4.2-23.3) of the racial inequality observed in CVD mortality risk (Table 1). Conclusions: The higher Black and “Pardo”/White CVD mortality risk is primarily explained by racial differences in SEF. Not using statins when there is indication for treatment increases in about 8% the CVD mortality risk for Blacks and “Pardos” compared to Whites.
Abstract P619: DNA Methylation at <i>SREBF1</i> and Long-Term Changes in Body Composition: The POUNDS Lost Trial
Authors: Xiang Li, Xiaojian Shao, Qiaochu Xue, Minghao Kou, Elin Grundberg, George A Bray, Frank M Sacks, Lu Qi
Journal: Circulation (2023)

Introduction: A previous epigenome-wide association study has causally linked DNA methylation (DNAm) at the SREBF1 gene (cg11024682) with obesity and lipids. However, little is known about whether DNAm at SREBF1 is associated with long-term changes in body adiposity and composition. Hypothesis: We hypothesized that participants with different DNAm at SRBF1 might respond differently to dietary weight-loss interventions on changes in body adiposity and composition. Methods: The current study included 314 individuals with overweight or obese, who participated in POUNDS Lost: a 2-year randomized dietary weight-loss trial. The blood DNAm level was profiled by methylC-capture sequencing at baseline. Regional DNAm at SREBF1 was calculated as the average methylation level over CpGs within ±250 bp of cg11024682. Body composition, including total fat mass (FM), percentage of FM (FM%), total fat-free mass (FFM), percentage of FFM (FFM%), and percentage of trunk fat (TF%) were measured by dual-energy X-ray absorptiometry (DEXA) at baseline, 6 months, and 2 years. Results: Lower regional DNAm at SREBF1 was significantly associated with changes in body composition across 2 years ( Table ). At 6 months, per SD lower regional DNAm at SREBF1 was significantly associated with greater reductions in FM (β [SE] -0.23 [0.07], p=0.002), FM% (-0.30 [0.09], p&lt;0.001), and TF% (-0.44 [0.13], p&lt;0.001), and greater increases in FFM (0.18 [0.08], p=0.028) and FFM% (0.30 [0.09], p&lt;0.001), regardless of dietary intervention groups and independent of concurrent weight loss. Such association remained at 2 years: FM (β [SE] -0.21 [0.10], p=0.045), FM% (-0.32 [0.11], p=0.004), TF% (-0.36 [0.16], p=0.026), FFM (0.22 [0.12], p=0.07) and FFM% (0.32 [0.11], p=0.004). Conclusions: Overweight and obese individuals with a lower regional DNAm at SREBF1 achieved greater improvement in body composition across the 2-year intervention, independent of concurrent weight loss, suggesting DNAm at SREBF1 is predictive of individuals’ response to treatment.
Abstract P624: Peripheral Artery Disease and Long-Term Risk of Femur Fracture Among Older Adults: The Atherosclerosis Risk in Communities Study
Authors: Mengkun Chen, Shoshana Ballew, Yejin Mok, Yingying Sang, Andrea Schneider, Morgan Grams, Laura R Loehr, Hirofumi Tanaka, Elizabeth Selvin, Josef Coresh, Kuni Matsushita
Journal: Circulation (2023)

Introduction: Femur fracture can have devastating consequences in older patients. Lower extremity peripheral artery disease (PAD) reduces physical function, which can in turn increase the risk of falls. However, less is known regarding the association of PAD with incident femur fracture in older adults. Hypothesis: PAD is associated with a higher risk of incident femur fracture independent of potential confounders. Methods: We included 5,276 participants from ARIC Visit 5 (2011-2013) (mean age 76 [standard deviation: 5] years, 57% women and 22% self-identified Black race). Femur fractures were defined as an outpatient encounter or hospitalization with ICD-9 codes: 820-821 or ICD-10 codes: S72. We quantified the association of PAD status at baseline, based on ankle-brachial index (ABI) ≤0.9 or clinical history of PAD, with incident femur fracture using multivariable Cox regression and follow-up until 2019. Results: There were 224 incident femur fractures over a median follow-up of 7.2 [IQI 5.6-7.8] years. The incidence rate of femur fracture was almost 2-times higher in participants with PAD compared to those without a history of PAD and ABI 1.11-1.20 (reference group) (10.5 [7.5-14.8] vs. 5.5 [4.3-6.9] per 1,000 person-years). This association persisted after accounting for demographic (hazards ratio [HR]: 1.86 [95% CI 1.23-2.84] in Model 1) and other confounders (HR 1.59 [1.04-2.46] in Model 2) (Table). When we excluded participants with a clinical history of PAD, low ABI (≤0.9) remained significantly associated with incident femur fracture compared to the reference group (HR 1.94 [1.18-3.19]). Our findings were consistent in demographic and clinical subgroups (e.g., by sex and diabetes status). Conclusions: In community-dwelling older adults, PAD, even when not clinically diagnosed, was associated with an increased risk of femur fracture. Clinicians and patients should be aware of this complication of PAD and consider preventive measures to avoid falls (e.g., exercise counseling, and making home safer).
Abstract P586: Patients With Heart Failure and Chronic Kidney Disease Affected by Pulmonary Hypertension Have Greater Risk of Mortality and Worse Clinical Outcomes
Authors: Leonid Khokhlov, Amanda Brown, Amr Aboelnasr, Michael Fatuyi, Leanne Pereira, Fatima Hussain, Mehnaaz Ali, Kamal Shemisa
Journal: Circulation (2023)

Background: Heart failure (HF) and chronic kidney disease (CKD) are increasingly prevalent diseases worldwide. Pulmonary hypertension (PH) is a known predictor of adverse outcomes. Nevertheless, there is limited scientific evidence of clinical outcomes of PH in patients with HF and CKD. Therefore, we sought to investigate this population. Methods: We queried NIS between 2016-2019 for adult patients who were hospitalized with HF and CKD and were affected by PH. The primary outcome was inpatient mortality. The secondary outcomes were cardiogenic shock, cardiac arrest, acute kidney injury (AKI), invasive mechanical ventilation, length of stay (LOS) and total hospital charge. Multivariable logistic and Poisson regression analyses were used to estimate clinical outcomes. P-value &lt; 0.05 was significant. Results: There were 9,221,158 patients with HF and CKD, of which 85,985 (4.3%) had PH. PH and non-PH cohorts were with mean age of 73.3 vs. 72.3 yrs; males 46.8% vs 55.1%; Caucasians 62.5% vs 63.2%; systolic HF 42.2% vs 41.7%; obesity 26.1% vs 22.2%; dyslipidemia 56.1% both; anemia 25.3% vs 21.9%, DM 54.3% vs 58.5%; AF 53.4% vs 41.5%; history of MI 14.4% vs 16.3%; stroke 1.6% vs 2.3%; COPD 39.6% vs 33.1%, smokers 9% vs 11%, respectively. PH cohort had significantly higher mortality and worse clinical outcomes (Table 1). Conclusion: HF patients with CKD who had PH showed significantly worse clinical outcomes and higher resource utilization. They were older, females, with more frequent systolic HF, obesity, anemia, AF, COPD. PH may raise risk for systolic dysfunction, cardiometabolic syndrome and lung disease. Hence, early detection and treatment of PH may improve clinical outcomes when managing patients with HF and CKD. Future studies may provide better understanding of this high-risk population.
Abstract P616: Implementing a Dietary Energy Density Intervention in Preschool Children
Authors: Shannon M Robson, Samantha M Sundermeir, Amanda K Fultz, Adriana Verdezoto Alvarado, Hollie A Raynor, Stephanie S Filigno, Matthew DiGuglielmo, Barry Bodt
Journal: Circulation (2023)

Introduction: The preschool years have been identified as a critical time to intervene on energy balance behaviors to halt the progression of obesity. In children, strategies for achieving physical activity recommendations are well established. Less clear are strategies for implementing an optimal dietary approach—one that maintains a healthy body weight and improves diet quality. Energy density (ED), the amount of energy per unit weight of food (kcal/g), may be a promising dietary approach. Hypothesis: We tested the hypothesis that a lower ED dietary approach will lower ED and energy intake and demonstrate better maintenance of body mass index (BMI z-score) than standard dietary recommendations in young children at risk for obesity. Methods: Thirty-six preschool children (3.5±1.1 years; 52.8% female; 52.8% White; 16.7% Hispanic or Latino; BMI percentile 56.8±22.2) and their parent (35.4±6.2 years; 86.1% female; 55.6% White; 13.9% Hispanic or Latino; BMI 38.2±5.4 kg/m 2 ) participated in a 6-month, 14-session, family-based behavioral intervention. Participants were randomized to a low-ED dietary approach (consume ≥10 foods/day with an ED ≤1.0 kcal/g and ≤2 foods/day with an ED ≥ 3.0 kcal/g; LOW-ED), or standard dietary recommendations (meet recommended daily servings of fruits, vegetables, and whole grains; STANDARD). Both interventions had physical activity goals of 60 minutes/day for children and 150 minutes/week for adults. Dietary and anthropometric assessments occurred at baseline and 6-months. Completer and intent-to-treat (ITT) analyses, with outliers removed, used repeated measures general linear mixed models to examine child change in ED (calculated as both all foods and beverages and food only), kcals, and BMI z-score from baseline to 6 months. Results: ITT analyses showed that the change in ED did not differ between the LOW-ED condition and STANDARD condition when calculated as for foods and beverages (LOW-ED: &amp;#916;-0.1 kcal/g vs. STANDARD: &amp;#916;+0.1 kcal/g, p = 0.12) or food only (LOW-ED: &amp;#916;-0.2 kcal/g vs. STANDARD: &amp;#916;+0.1 kcal/g, p = 0.06). There was a significant time by condition interaction with kcals/d decreasing in LOW-ED and increasing in STANDARD over time for completers (LOW-ED: &amp;#916;-98 kcals vs. STANDARD: &amp;#916;+212 kcals, p = 0.04), but not when using ITT (LOW-ED: &amp;#916;+5 kcals vs. STANDARD: &amp;#916;+211 kcals, p = 0.09). Under ITT BMI z-score had a main effect of time, with both LOW-ED and STANDARD conditions significantly increasing over time (p=0.03). Conclusion: In conclusion, these data suggest a LOW-ED dietary approach is an alternative way to lower ED and energy intake in young children at risk for obesity.
Abstract P259: Associations of Adverse Childhood Experiences With Cardiovascular Health (Life’s Essential 8) Among Women in Midlife
Authors: Sheryl L Rifas-Shiman, Marie-France Hivert, Jorge E Chavarro, Janet Rich-Edwards, Emily Oken
Journal: Circulation (2023)

Introduction: Many women experience suboptimal cardiovascular health (CVH) during midlife and CVH is related to upstream social, behavioral and environmental factors. However, associations of adverse childhood experiences (ACEs) - more common among women - with CVH are understudied. Hypothesis: ACEs would be associated with poorer CVH among women in midlife. Methods: At mean (SD) 50.9 (5.1) years, participants in the Project Viva cohort completed questionnaires and research staff measured their height, weight, blood pressure, and blood levels of glucose, HbA1c and cholesterol. We calculated Life’s Essential 8 (LE8), a 0-100-point score that includes 8 components of CVH: heart healthy levels of diet, physical activity, sleep, avoidance of nicotine, body mass index (BMI), blood lipids, blood glucose and blood pressure. In 2021, women reported their personal history of ACEs (10 possible types) prior to age 18y. We used linear regression models adjusted for childhood SES measures (race/ethnicity, parental education, US birth) and age at outcome. Results: Among 319 participants, 114 (36%) reported 0 ACEs and 58 (18%) reported ≥4 ACEs. In midlife, mean (SD) LE8 score was 77 (12) points. In age-adjusted models, ACEs (4+ vs 0) were associated with poorer LE8 score (β -6.15; 95% CI -9.91, -2.40) and behavioral (β -5.84; CI -9.98, -1.69) and biological (β -6.47; CI -11.8, -1.12) domains; covariate adjustment attenuated the results, though the trends remained significant for LE8 and behavioral domain (Figure). In fully adjusted models, each additional ACE was associated with poorer LE8 score (β -0.74; CI -1.44, -0.04) and associations were stronger for ACEs related to abuse (β -2.72; CI -5.57, 0.12) and neglect (-2.48; CI -5.81, 0.85). Of the LE8 components (0-100-points), associations were strongest for glucose (β -1.76; CI -2.85, -0.67) and physical activity (β -1.86; CI -3.92, 0.20). Conclusions: Adverse childhood experiences may have persistent associations with several measures of cardiovascular health among women into midlife.
Abstract P669: Inflammatory Markers and Calcification of Coronary Arteries, Aorta and Cardiac Valves in Older Adults: Findings From the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Vennela Avula, Yejin Mok, Kentaro Ejiri, Jeremy Van't Hof, Seamus P Whelton, Ron C Hoogeveen, Christie M Ballantyne, Matthew Budoff, Michael J Blaha, Kunihiro Matsushita
Journal: Circulation (2023)

Background: Inflammation plays an important role in the pathophysiology of atherosclerosis. However, inflammatory biomarkers have been found to have a weak association with coronary artery calcium (CAC), a representative measure of subclinical atherosclerosis. Moreover, the existing evidence does not sufficiently explore extra coronary calcium (ECC) in this context. Aim: To characterize the association of two inflammatory markers, high-sensitivity C-reactive protein (hs-CRP) and galectin-3, with CAC and ECC in a community-based cohort. Methods: Cardiac CT was performed among 1,934 ARIC participants (age 53-74 years) without coronary heart disease at visit 7 (2018-19). We examined the associations of hs-CRP and galectin-3 measured in middle age at visit 4 (1996-98) by quartile with the presence of CAC and ECC (Agatston score &gt;0 vs. 0) using multivariable logistic regression. Results: Higher hs-CRP was associated with calcifications in the ascending aorta, aortic valve ring, mitral valve and right coronary artery in the unadjusted model (Table). These associations were mostly attenuated after adjusting for potential confounders, but the associations with ascending aorta and right coronary artery calcifications remained significant (adjusted odds ratio (aOR) = 1.45 [95% CI = 1.02-2.07]) and (1.55 [1.12-2.16]) for the highest vs. lowest quartiles, respectively). Galectin-3 was also independently associated with right coronary artery calcification after adjusting for potential confounders (aOR 1.48 [1.02 - 2.01]) for the highest vs. lowest quartiles). These associations were generally consistent in demographic subgroups. Conclusions: Both hs-CRP and galectin-3 were associated with calcification of some but not all vascular beds tested, suggesting potentially unique atherosclerotic pathophysiology across different vascular beds. Robust associations of inflammatory markers with right coronary artery calcification deserve further investigation.
Abstract P382: Blood Pressure Outcomes After 12 Months in Primary Care: A Prospective Cohort Study in Electronic Health Records Using Propensity Score Matching for Remote Patient Monitoring for Hypertension
Authors: Lucia Petito, Ji Young Lee, Yaw Peprah, Lauren Anthony, Jim Li, Hironori Sato, Stephen D Persell
Journal: Circulation (2023)

Introduction: In primary care (PC) settings, more hands-on hypertension management may be enabled by remote patient monitoring (RPM) for blood pressure (BP), leading to greater BP control over time Hypothesis: Individuals prescribed RPM will have better BP control (BP &lt;140/90 mmHg) and lower office SBP after 12 months, compared with temporally-matched controls. Methods: We conducted a pragmatic matched cohort study in Medicare-enrolled patients with Hypertension at six PC practices, 288 of whom participated in pilot studies of a Omron VitalSight TM RPM system that enabled automatic transmission of BP and pulse into the electronic health record (EHR). We used 1:4 propensity score matching to identify 1152 contemporary matches for these patients from the same PC practices, based on age, sex, systolic BP (SBP), marital status, and several other clinical and healthcare visit characteristics. Outcomes after 12 months included controlling high blood pressure (most recent BP &lt;140/90 mm Hg), and most recent systolic BP and diastolic BP, assessed 1) using PC office measurements only and 2) incorporating RPM measurements. Results: The matched cohort of 1152 patients was, on average, 74 (SD 8) years old, 71% female, and 71% non-Hispanic white. Average baseline systolic BP (SD) was similar between groups: 142.7 (19.5) and 141.2 (18.7) mm Hg in RPM-prescribed patients and controls, respectively (Table). Compared with matched controls, after 12 months the RPM-prescribed cohort had greater BP control (72.6% versus 65.6%) and lower systolic BP (132.3 versus 136.6 mm Hg) when including RPM measurements. However, these metrics were similar when using PC office measurements only. Conclusions: Greater BP control and lower SBP were observed after 12 months in RPM-prescribed patients when considering RPM measurements. Further studies will assess the contributions of adherence to RPM use to observed declines in BP. The EHR can be used to prospectively construct and conduct cohort studies.
Abstract P639: Sex Modifies the Association of Socioeconomic Status With Life’s Essential 8
Authors: Amaris Williams, Joshua J Joseph
Journal: Circulation (2023)

Introduction: Higher scores for American Heart Association (AHA) Life’s Essential 8 (LE8) metrics, blood pressure, cholesterol, glucose, body mass index, physical activity, smoking, sleep, and diet, are associated with lower risk of chronic disease. Socioeconomic status (SES; education &amp; income) is associated with LE8 metrics, but there is limited understanding of potential differences by sex. Methods: Using data from the continuous National Health and Nutrition Examination Survey, years 2011-2018, LE8 scores were calculated based on AHA guidelines with a point score of 0-100. Age-adjusted linear regression was used to quantify the association of SES with LE8 score. An interaction term was placed in the model to test the interaction of sex with SES in the association with LE8 score among men and women of each racial/ethnic group. Results: The US population representatively weighted sample (n = 13,626) was aged 20 years or older (median 48 years). Non-Hispanic Black and White American (NHBA &amp; NHWA) women had a greater magnitude of positive association of education and income with LE8 scores than men of the same racial groups (p for all interactions &lt; 0.05), due to women having higher LE8 scores at higher education and income levels and no difference between the sexes at low education and income levels. Among non-Hispanic Asian (NHAA) and Hispanic Americans (HA), the association of SES with LE8 was the same in men and women, and women had greater LE8 scores compared to men at all levels of SES (i.e. High school or less, some college, and college degree or more). Conclusions: Women have the greatest magnitude of association of socioeconomic status with LE8 scores among NHBA and NHWA, but not NHAA and HA. Potential explanations for findings in NHBA and NHWA include caregiver burden among women, sex-based discrimination, gender norms that inhibit men from accessing preventive medical care, and careers available to each sex. There is a paucity of research on sex differences in variables that affect SES and cardiovascular health among NHAA and HA.
Abstract P654: Neighborhood Social Determinants of Health Influence Cardioprotective Behaviors Among Church Members in New Orleans
Authors: Flor Alvarado, Jodie Laurent, Katherine T Mills, Keith C Ferdinand, Deidra Crews, Jeanette Gustat, Jiang He
Journal: Circulation (2023)

Introduction: Favorable neighborhood-level social determinants of health (SDOH) are associated with less cardiovascular disease risk, but there is limited research evaluating their influence on cardioprotective behaviors. We evaluated the association between neighborhood-level SDOH and cardioprotective behaviors among members of predominantly Black churches in New Orleans, LA. Hypothesis: Participants residing in more-resourced neighborhoods will be more likely to engage in cardioprotective behaviors than participants residing in less-resourced neighborhoods. Methods: A health needs assessment was conducted during the planning phase of a local church-based health intervention. It included a survey distributed between November 2021-February 2022 to church members on their demographics, engagement in health-related behaviors, aspects of the neighborhood environment, and home address (which was linked to their census tract data and a corresponding social deprivation index [SDI]). We conducted descriptive analyses and multivariable logistic regression models to assess the influence of neighborhood predictor variables on the likelihood of engaging in cardioprotective behaviors. Results: Overall, there were 302 respondents, 77% were female, 99% were of Black race, and 50% completed an associate’s/bachelor’s degree or higher. Neighborhood social cohesion, availability of fruits and vegetables, and the neighborhood’s walkability and conduciveness to exercise were positively associated with the composite outcome of beneficial health behaviors after adjusting for age, sex, and education. [Table] Neighborhood predictors were not associated with medication adherence or regular medical care. Conclusions: Neighborhood-level SDOH were associated with cardioprotective behaviors in this group of predominantly Black church members in New Orleans.